Healthcare Provider Details

I. General information

NPI: 1932860822
Provider Name (Legal Business Name): KATIA HAYDAR RP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST
LEBANON PA
17046-4656
US

IV. Provider business mailing address

1531 FISHBURN RD APT 3
HERSHEY PA
17033-1821
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-2700
  • Fax:
Mailing address:
  • Phone: 717-775-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP456377
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: